Nearly 800 women in the U.S. and its territories have tested positive for a Zika infection. A dozen babies have been born with birth defects. In the past few weeks, researchers learned that in addition to spreading by mosquito bite, the disease can be sexually transmitted. An elderly man in Utah inexplicably passed along the virus to his caregiver. Two cases in Florida are suspected of being the first in the U.S. to have been transmitted by local mosquitoes.
And yet, Congress left for its seven week summer break without approving President Barack Obama's request for $1.9 billion to deal with Zika.
The question asked by public health officials, lawmakers and patient advocates is: why?
Republicans argue that the funding could wait for the formal appropriations process, which is subject to caps. And in an election year, with many GOP incumbents facing challenges, lawmakers aren't likely to open up the federal pocketbook without seeking cuts elsewhere. The Obama administration, some Democratic lawmakers and public health officials say the answer is a stable, permanent fund to fight future disease outbreaks.
At an event sponsored by the New America think tank, CDC Director Dr. Tom Frieden said global health threats are becoming a new normal and “speed really matters” when it comes to saving lives.
Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said that waiting for a public health disaster and then debating funding is far from the best way to respond to crises.
“The way we do things right now is highly dysfunctional,” he said.
He says Congress does not have a good track record of responding well to such issues.
“I'm not optimistic that the Democrats and Republicans can get their act together and agree on this,” he said.
The World Health Organization has said $122.1 million is needed through December 2017 to combat the virus. And while a popular Republican argument against emergency funding is that the money could be redirected, some know exactly where they want to spend it.
Ron Klain, who was in charge of the administration's response to Ebola, said the CDC lacks the logistical capabilities for full emergency response and Federal Emergency Management Agency lacks the medical expertise necessary for responding to an outbreak.
“What is needed, then, is a new specialized agency ... that could combine key resources and talents from these two agencies to prepare for, train for, and then execute a response to a full-fledged outbreak of a deadly infectious disease in an American city,” he said.
A bipartisan group of five senators has proposed such a permanent fund, but the legislation was introduced a day after lawmakers left for the summer break.
Sen. Bill Cassidy (R-La.) said in a statement that the legislation would create immediate resources in the case of a public health emergency like Zika.
“The pattern is well known, an outbreak of disease occurs, public panic grows, Congress scrambles and appropriates money,” he said. “This is an inefficient and dangerous way to deal with public health emergencies. As a doctor, with a background in public health, I know there is a better way.”
Rep. Rosa DeLaura (D-Conn.) has proposed a $5 billion fund and Republican Reps. Kevin McCarthy of California and Hal Rogers of Kentucky has suggest a fund with $300 million.
Hotez said his biggest worry is that transmission has begun in southern Florida but is not being tracked. Some local health departments have enough staff and money to perform the needed active surveillance and mosquito control, but others don't have any resources for those activities.
Those areas could be hard hit this summer, because “the critical period is now,” he said.
Josh Michaud, associate director of global health policy at the Kaiser Family Foundation, said any of those proposals would be helpful for future outbreaks, but the window for approving money as an emergency response to Zika "is almost closed" as the end of the fiscal year looms.
FEMA regulations do not allow for response to health disasters and the HHS has no FEMA-like capability, he said.
"It's kind of like a gap in emergency preparedness," he said.
It appears that part of the reason Congress and private donors have been less willing to provide funding for Zika is because the most drastic affects are limited to pregnant women and their babies, whose emergency health needs are lifelong but not immediately apparent. Ebola, however, was frequently fatal and killed people of all ages. Zika, though, is far more likely than Ebola to affect people in the U.S.
"Ebola is a much more dramatic, in-your-face disease," Michaud said, adding, "It's just a completely different type of threat."
The public appears to support increased funding for Zika. An Annenberg Public Policy Center Poll showed that more than 60% of people supported a fund the president could draw from for public health emergencies.
A recent Kaiser Family Foundation poll found 73% of respondents thought the country should invest more money in researching the virus and 72% wanted more money to prevent the spread of Zika in the U.S.
Congress did create a public health emergency fund in 1983, but it currently has about $57,000 in it and by law could be brought up to only $30 million.